This educational activity explores evidence-based approaches to the management of thoracoabdominal aortic aneurysm, including appropriate thresholds for surgical intervention and referral to multidisciplinary aortic centers. Faculty examine patient-specific factors that guide the selection of open versus fenestrated-branched endovascular repair, contemporary strategies for spinal cord protection, and the importance of lifelong surveillance after repair. The activity also addresses the role of family screening and genetic counseling for patients with hereditary thoracic aortic disease.